BACKGROUND Spontaneous coronary artery dissection(SCAD)is underdiagnosed and requires comprehensive angiographic findings.Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome(TTS)or exist s...BACKGROUND Spontaneous coronary artery dissection(SCAD)is underdiagnosed and requires comprehensive angiographic findings.Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome(TTS)or exist simultaneously,making it challenging for clinicians to treat and manage.Case reports lack consolidated AIM To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.METHODS SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed,EMBASE,Scopus,and Google Scholar databases till January 2023.Case reports described demographics,comorbidities,imaging,management,and results.RESULTS Twelve articles about 20 female patients were analyzed.30%of patients(n=6,>60 years)were elderly(mean age 56.2±9.07 years,range 36-70 years).Canada has 9 cases,United States 3,Australia 3,Sweden 2,Japan,Denmark,and France 1.Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS.Nine had hypertension,2 had hyperlipidemia,and 1 had prediabetes.5 patients(25%)smoked.10(50%)troponin-positive myocardial infarction patients reported chest discomfort.11(55%)of 20 instances had TTS/SCAD.12(60%)of 20 patients exhibited ST elevation and 3(15%)had T wave inversion on electrocardiogram.19/20 patients had elevated troponin.9(45%)of 20 people had apical akinesis with TTS ballooning on cardiac imaging.All 20 exhibited echocardiographic wall motion abnormalities.19(95%)of 20 coronary angiography cases had SCAD.10 of 19 SCAD patients had left anterior descending,2 diagonal,and 2 left circumflex coronary artery involvement.7 of 20 patients had left ventricular ejection fraction(LVEF)data.LVEF averaged 38.78±7.35%.5(25%)of the 20 cases underwent dual antiplatelet therapy.Three(15%)of 20 cases experienced occasional ectopic ventricular complexes,Mobitz ll AV block,and paroxysmal atrial fibrillation.All 20 cases recovered and survived.CONCLUSION Given the clinical similarities and challenges in detecting TTS and SCAD,this subset needs more research to raise awareness and reduce morbidity.展开更多
A 78-year-old woman with a background of type 2 diabetes mellitus,hyperlipidaemia and hypertension experienced sudden onset severe chest pain while in the emergency department,after a stressful emotional event.The pai...A 78-year-old woman with a background of type 2 diabetes mellitus,hyperlipidaemia and hypertension experienced sudden onset severe chest pain while in the emergency department,after a stressful emotional event.The pain lasted for 20-30 min and the patient developed widespread T-wave inversion on 12-lead ECG.展开更多
BACKGROUND The pathophysiology of takotsubo syndrome(TTS)is not well understood,however,it is often precipitated by psychological or physical stress.Marital status is related to emotional stress,but its associations w...BACKGROUND The pathophysiology of takotsubo syndrome(TTS)is not well understood,however,it is often precipitated by psychological or physical stress.Marital status is related to emotional stress,but its associations with TTS are limited.AIM To explored the potential association between marital status and TTS.METHODS We conducted a case-control study using data on patients aged≥40 years with marital status data in the National Hospital Discharge Survey(2006-2010).The International Classification of Diseases Ninth Revision codes were used to identify cases with TTS and other comorbid conditions.Each case was matched to 5 controls by age,sex,year of TTS diagnosis and bed size of hospital.Two sets of controls were selected:Acute myocardial infarction(AMI)controls and noncardiovascular disease(CVD)controls.Conditional logistic regression was used to estimate odds ratios(OR)and 95%confidence intervals(CI)for the association of marital status with TTS.RESULTS The 59 patients with TTS who had information on marital status were matched to 295 controls with AMI and 295 non-CVD controls,resulting in a sample of 649 patients.The average age of cases was 69.7±11 years with 90%being women and 88%reporting White race.In multivariable-adjusted models,compared to singles,patients who were married had lower odds of TTS(OR=0.86,95%CI:0.79–0.93)while those who were widowed(OR=1.14,95%CI:1.05–1.23)or divorced/separated(OR=1.32,95%CI:1.21–1.45)had elevated odds for TTS when compared to non-CVD controls.Similar results were observed when cases were compared to controls with AMI.CONCLUSION In this study,being married was associated with lower odds for TTS while being divorced/separated or widowed was related to elevated odds for TTS.These novel findings that underscore the potential importance of social factors like marital status in the development of TTS need confirmation in larger studies.展开更多
We read with great interest case report of 99-year-old patient with takotsubo syndrome(TTS)presented by Yenerçağ,et al.,[1]especially because four years ago,we described the oldest so far person diagnosed with TT...We read with great interest case report of 99-year-old patient with takotsubo syndrome(TTS)presented by Yenerçağ,et al.,[1]especially because four years ago,we described the oldest so far person diagnosed with TTS:a 98-year old woman.[2]During analysis of your article a few comments and questions occurred to us.TTS is usually preceded with a stress factor.[3]Do you know,or can you suspect the TTS cause in this patient?Was she diagnosed with primary or secondary TTS?TTS often occurs in people with ongoing or previous neurological or psychiatric disorder.[4]The patient had history of Alzheimer’s disease.Did she have any new neurological symptoms during described hospitalization?A very good diagnostic test for TTS is NT-proBNP to troponin I ratio.[5]展开更多
文摘BACKGROUND Spontaneous coronary artery dissection(SCAD)is underdiagnosed and requires comprehensive angiographic findings.Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome(TTS)or exist simultaneously,making it challenging for clinicians to treat and manage.Case reports lack consolidated AIM To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.METHODS SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed,EMBASE,Scopus,and Google Scholar databases till January 2023.Case reports described demographics,comorbidities,imaging,management,and results.RESULTS Twelve articles about 20 female patients were analyzed.30%of patients(n=6,>60 years)were elderly(mean age 56.2±9.07 years,range 36-70 years).Canada has 9 cases,United States 3,Australia 3,Sweden 2,Japan,Denmark,and France 1.Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS.Nine had hypertension,2 had hyperlipidemia,and 1 had prediabetes.5 patients(25%)smoked.10(50%)troponin-positive myocardial infarction patients reported chest discomfort.11(55%)of 20 instances had TTS/SCAD.12(60%)of 20 patients exhibited ST elevation and 3(15%)had T wave inversion on electrocardiogram.19/20 patients had elevated troponin.9(45%)of 20 people had apical akinesis with TTS ballooning on cardiac imaging.All 20 exhibited echocardiographic wall motion abnormalities.19(95%)of 20 coronary angiography cases had SCAD.10 of 19 SCAD patients had left anterior descending,2 diagonal,and 2 left circumflex coronary artery involvement.7 of 20 patients had left ventricular ejection fraction(LVEF)data.LVEF averaged 38.78±7.35%.5(25%)of the 20 cases underwent dual antiplatelet therapy.Three(15%)of 20 cases experienced occasional ectopic ventricular complexes,Mobitz ll AV block,and paroxysmal atrial fibrillation.All 20 cases recovered and survived.CONCLUSION Given the clinical similarities and challenges in detecting TTS and SCAD,this subset needs more research to raise awareness and reduce morbidity.
文摘A 78-year-old woman with a background of type 2 diabetes mellitus,hyperlipidaemia and hypertension experienced sudden onset severe chest pain while in the emergency department,after a stressful emotional event.The pain lasted for 20-30 min and the patient developed widespread T-wave inversion on 12-lead ECG.
文摘BACKGROUND The pathophysiology of takotsubo syndrome(TTS)is not well understood,however,it is often precipitated by psychological or physical stress.Marital status is related to emotional stress,but its associations with TTS are limited.AIM To explored the potential association between marital status and TTS.METHODS We conducted a case-control study using data on patients aged≥40 years with marital status data in the National Hospital Discharge Survey(2006-2010).The International Classification of Diseases Ninth Revision codes were used to identify cases with TTS and other comorbid conditions.Each case was matched to 5 controls by age,sex,year of TTS diagnosis and bed size of hospital.Two sets of controls were selected:Acute myocardial infarction(AMI)controls and noncardiovascular disease(CVD)controls.Conditional logistic regression was used to estimate odds ratios(OR)and 95%confidence intervals(CI)for the association of marital status with TTS.RESULTS The 59 patients with TTS who had information on marital status were matched to 295 controls with AMI and 295 non-CVD controls,resulting in a sample of 649 patients.The average age of cases was 69.7±11 years with 90%being women and 88%reporting White race.In multivariable-adjusted models,compared to singles,patients who were married had lower odds of TTS(OR=0.86,95%CI:0.79–0.93)while those who were widowed(OR=1.14,95%CI:1.05–1.23)or divorced/separated(OR=1.32,95%CI:1.21–1.45)had elevated odds for TTS when compared to non-CVD controls.Similar results were observed when cases were compared to controls with AMI.CONCLUSION In this study,being married was associated with lower odds for TTS while being divorced/separated or widowed was related to elevated odds for TTS.These novel findings that underscore the potential importance of social factors like marital status in the development of TTS need confirmation in larger studies.
文摘We read with great interest case report of 99-year-old patient with takotsubo syndrome(TTS)presented by Yenerçağ,et al.,[1]especially because four years ago,we described the oldest so far person diagnosed with TTS:a 98-year old woman.[2]During analysis of your article a few comments and questions occurred to us.TTS is usually preceded with a stress factor.[3]Do you know,or can you suspect the TTS cause in this patient?Was she diagnosed with primary or secondary TTS?TTS often occurs in people with ongoing or previous neurological or psychiatric disorder.[4]The patient had history of Alzheimer’s disease.Did she have any new neurological symptoms during described hospitalization?A very good diagnostic test for TTS is NT-proBNP to troponin I ratio.[5]
